What do Barry Bonds and Medicare have in common?
Bookworm on May 19 2011 at 8:14 am | Filed under: Government, Health
I like to consider myself a true and patriotic American, but I have a confession to make: I hate baseball. Yes, I know it’s the quintessential American sport, right up there in Americana with Mom and apple pie. But I still hate it. I find it boring and surprisingly non-athletic. It’s such a static game. The guys run bases periodically, but mostly they just stand around. Oh, and they hit balls. And of course, they spit.
I’ll concede that the ball hitting part is a real skill. With a surprisingly small stick, baseball players manage to whack away with great precision at a small, incredibly fast moving ball. That’s impressive . . . but still boring. Kind of like darts, which is fun to play (especially if you’re a little beer lubricated, but really not that exciting to watch).
Here’s something I learned from Barry Bonds, though: the bigger your muscles, the harder you can hit that little ball, and the further and faster that ball then travels. That fast and far travel means either that (a) the ball goes right out of the park or (b) nobody can catch it within the park.
Bonds’ problem when he began his baseball career was that he wasn’t born with those muscles. He had to create them artificially. Enter steroids. With steroids on his side, and a strong natural and honed talent for hitting balls with frequency and precision, Bonds became a bulging behemoth who could effortlessly hit balls further and faster than anyone else.
Forget about all the icky little side effects that come with steroids, such as shrunken testicles, damaged joints, pustule covered skin, and surging anger, not to mention the whole law-breaking thing. Bonds was hitting the big time, becoming a baseball hero and one of the most famous men in the world.
When the Bonds story first broke, I asked myself one question: Why shouldn’t players in a commercial enterprise be allowed to do anything they want to become the best? After all, the downsides of steroids are centered on the individual himself. The individual is the one who makes the Faustian bargain: In exchange for destroying his health, he has a brief moment as a superb baseball player. Isn’t that a private bargain, that isn’t anyone else’s business?
In fact, though, it is also other people’s business, since it affects the other baseball players. Those players who take steroids distort the market. The up and coming player no longer needs to have only innate talent and an enormous work ethic. Instead, to compete in this distorted market, he too needs to be willing to destroy himself.
One could argue that the market place will adjust: ultimately, America would end up with two leagues, one filled with weird, steroid bulging, slow-moving hard hitters, and one filled with “all natural” players, lithe and quick. Those who wish to poison themselves can, those who don’t want to won’t.
The specter of grotesqueries, however, not to mention the fear of legions of young men hitting the steroids to going into the steroid league (and that’s just what we need — teenagers on steroids), meant that we, as a society, decided that we didn’t want to go down that road. Instead, the Major League Baseball machine, law enforcement, and public opinion all agitated against the distortion of the current baseball market that Bonds and his ilk represented.
Right now, I imagine many of you saying, “Fine, you’ve insulted baseball left, right and center. You also maundered on about steroids and the free market. But what does this have to do with health care?” My answer: “This whole baseball riff is a perfect illustration of the problem with government interference in the health care market.”
In the context of health care, government money is the functional equivalent of steroids. The huge, bumbling, slow moving, inefficient, corruption-prone government behemoth places huge chunks of money into the market and, just as Barry Bonds’ distorted normal baseball, so too does Medicare (and Medicaid and ObamaCare) distort the normal market. I’ll let the Center for Freedom and Prosperity Foundation explain:
I think the video is remarkably clear but, if it’s not, just think of the way in which Barry Bonds, by tossing steroids into the baseball mix, perverted and potentially destroyed baseball. The same holds true for a system that has clunky government rules, combined with third party money that diminishes anyone’s interest in honesty and efficiency.
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63 Responses to “What do Barry Bonds and Medicare have in common?”
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I never got interested in the strategy of baseball until I watched Cross Game, a Japanese show. That one made baseball and teamplay fun.
Even if you have one super hard hitter, who is placed 4th in the lineup (so called cleanup hitter), that’s just one person. And the other team can easily run him off with 4 balls. He can hit the ball far, but he can’t get the points in and he can’t stop the other team from getting points in.
Hate to say it Book, but you fall into the familiar trap of critiquing that which you don’t understand.
All of the criticisms of baseball are accurate, and irrelevant.
But then again, most of the world loves soccer, futbal, or whatever your term of choice. I cannot stand it–as a spectator sport. (I tolerate my obsessed grandchildren’s practices and games. It is my grandfatherly duty.) My wife tells me frequently that I don’t understand the game. She is undoubtedly correct.
Now, have I succeeded in distorting and detouring your original point?
I’m with Oldflyer—and his wife—on soccer. I don’t like the sport, but I’m outnumbered in my opinion by about 4 billion people. So there must be something to it that I don’t get, and I’m happy to acknowledge it.
Which brings me to baseball: I get Book’s take on it the same way I get my own take on soccer. Like any human activity that seems boring on the surface—stamp collecting, curling, listening to Hillary make a speech—there are depths and subtleties not apparent to the untrained. It took me years to realize what a tango baseball is, with elaborate plots, sub-plots, hostile maneuvers, distractions and cold calculations going on every second of the game. I imagine a soccer fan sees the same when watching a game that for him is pure excitement yet for me is the spectacle of men imitating chickens that have suddenly been beheaded.
The one thing you can say for Bonds, as opposed to the apparently endless list of stuff you can say against him, is that steroids are, for lack of a better term, pretty much one-dimensional in their effect. They made him strong, so when he hit the ball he was able to bring more muscle to bear, and, theoretically, the ball would travel farther
Okay, but he still had to go through several steps before he got to that point. He still had to see the pitcher’s arm and spot the ball the instant – and I mean the instant, because it’ll be at the plate in under two seconds – it left the pitcher’s hand. Having done that he had to then process what was coming at him: a curve? A slider? A fastball? A change-up? They all behave differently in their approach to the plate (which, let us recall, happens in under two seconds.) Having – virtually instantaneously – processed what was coming at him, he then had to factor in the probable behavior of the ball – high? Low? Inside? Outside? Straight across the middle of the plate? Having computed that faster than anything IBM ever built could, he then had to adjust his body to what was coming at him. Do I flex to get down a little? It’s going to be outside, can I lengthen my extension and reach it solidly enough to do anything with it? It’s high, can I lengthen my arms to get up there and do anything with it? It’s inside, is enough of it over the plate that I shorten and have a chance to drive it? Or – it’ll be a ball, let it go.
Steroids did not help his eyeballs and their connection to his brain at all. Processing the message from the eyeballs and acting on that information, taking his stance – instantly, remember – down, up, inside, outside etc. – was not assisted by steroids. In the midst of all this physical manipulation, he still had to allow a millisecond to get himself cocked, so once he’d decided that he was indeed going to swing, he’d be able to do so with some verve.
Provided he did all of that successfully, his bat would meet the ball – about two and half times out of ten. Now – finally – at this stage, there’s some benefit realized from all of that extra muscle. He could half miss the ball and still connect solidly enough to drive it. And, with the extra muscle mass, he could take pitchers over the wall most guys simply aren’t strong enough to hit homers off. (A goodknuckleball hit for a home run was powered solely by the strength of the batter. A good live fastball does almost half the work for the batter – the pop on the ball makes it easier to hit long. It comes in faster, leaves the bat faster, and goes farther. Fastball pitchers give up lots more home runs than knuckleball or other slow ball pitchers do.) His additional muscle probably picked him up an extra dozen or fifteen home runs a year based on his sheer strength.
But all the stuff he had to do,and had to do correctly to be in a position to hit the home run- the calculations, adjustments, etc. – wasn’t aided at all by steroids. Are steroids cheating? Yeah, they are. But the fact that he was pretty damn good at his job to begin with shouldn’t be entirely lost, either.
I guess I don’t know where I stand on this one. Mickey Mantle spent his entire career in pain, and popped plenty of balls over the walls when he was half drunk, because he didn’t hurt so much when buzzed. So is booze a “performance-enhancing” substance? In his case – yeah, it was. Should drinking during the season be banned? Ya got me – I don’t know.
Great analogy, Book! I think you’re right on the money with the comparison of distortional effects.
Book: The specter of grotesqueries, however, not to mention the fear of legions of young men hitting the steroids to going into the steroid league (and that’s just what we need — teenagers on steroids)
Here in Texas, where football is King (and Queen, and in fact all of royalty), they had a large problem in the high schools with steroids back during this baseball scandal. (I haven’t followed it since; the problem may well still be just as huge.) Coaches were sometimes even supplying their players with the drugs. And you’re right about the distortional effects: The pressure to nail down that rare, precious athletic scholarship could be so intense, that the steroid abuse was most rampant among those with the most skill.
I learned long ago that when something sounds too good to be true, it usually is. The health care sector is large and enormously complex, yet the definition of the problem and solutions offered sound so simple, according to the video, and the CATO institute “research” behind it, that it should make one suspicious. For those that have researched this issue, and are in command of the many facts left out by this video, it is really rather flawed in its analysis.
First, one should summarize the claims made in this video and in the CATO materials referenced here. The health care system is flawed by two key aspects: 1) third-party payment and the adverse incentives that occur when you are spending other people’s money; and 2) big government bureaucracy that is inherently problematic for addressing the complexity of health care. These are both legitimate concerns, and if the world were as simple as CATO would have you believe, then addressing these problems by increasing first party payments and removing the government from the system would make sense. But there is much that CATO leaves out of the story.
The first thing to understand is that there is no free market for delivering ethical health care anywhere in the world, including ueber-laissez-faire economies like Hong Kong. And there is a reason for this. Ethical health care has inherent market failures that make such a free market system impossible to implement. As long as we continue to believe that human beings are more than economic commodities, ethical health care is already in a class by itself. We as a society can ask the less fortunate among us to give up Ferrari’s and Rolexes with no problem. However, we cannot tell old ladies or little kids to simply die outside an ER if they lack the funds to cover health care expenses. Beyond this obvious distinction, health care has a ton of other aspects that do not fit the basic assumptions for a free market (to wit, atomized buyers and sellers, fungibility of product and substitutes, free flow of information, etc.). Drug companies hold monopolies. Drug companies and doctors enjoy information advantages. Patients and their families often need to make health care decisions under duress. And I could go on. In light of this, it is beyond naive to claim that the free market will handle ethical health care delivery as it does the production and distribution of “cell phones, food, furniture and shampoo,” as the guy in this video claims. Regulation and government involvement in health care is required, just as it is for the delivery of utility services at the distribution level, or how it is for military, police and fire protection.
The second thing to understand is that third party payment is not necessarily linked to government, as seems implied in the video. Indeed, the 50% of the US health care market that consists of non-government payers is mostly third party as well. This is why we have health insurance companies. And what is extremely interesting is to see the return on tangible equity for those companies, which is amongst the highest of any sector of the economy and far in excess of market averages. So the problem of waste, fraud, abuse, etc. appears to exist on the private side as well, although CATO ignores it. As an aside, it is also interesting to note that health care costs are skyrocketing on the private-payer side at a much higher rate than on the government payer side, as has been pointed out repeatedly by health care economists and other well known economists. Of course, the third party payment is unavoidable, since it is essentially part of the insurance function of health care. We have constructed a system in which the most costly cases are subsidized by the rest of us, since those cases are too expensive for all but the most wealthy of us to afford. It also is true that the young subsidize the old under these insurnace schemes, whether they are public or private in nature.
In light of this context, it is rather silly to pose as a choice the free market and no-third-party-payment versus government regulated and third-party-payment as a frame of reference. No economist would do this. Only partisan hacks would.
The reality is that health care costs are exploding as a percentage of GDP on the private side even more than on the public side, which is driven by the fee-for-service incentives of doctors, the for-profit motives of all the private companies in the health care sector, as well as the technological advances that make the price of health care higher than it used to be. The key is to address the market failures in order to ensure that the expenses line up with outcomes, which they currently do not. As Atul Gawande has repeatedly written about, there is actually a NEGATIVE correlation between the cost of health care and the quality of outcomes, but between the US and other leading countries, and across various places inside the US. Free market systems exacerbate, rather than mitigate, these negative correlations. The idea of benchmarking, which Palin famously called the formation of death panels, was actually an attempt to address this key problem. And while Palin is curiously not upset about how a free market’s pricing mechanisms rationalizes care, she screamed loudly about government rationing. But setting aside her politically-calculated scare mongering, such a system of implementing best practices is necessary to address the market failures in the system. Other solutions, which CATO and most conservatives have resisted, include government negotiating monolithically against drug companies despite the fact that the purchase economies enjoyed by Walmart would also accrue to the government and tax payer; restrictions on the ability of drug companies to hide adverse studies is another example. These would help address the high rate of health care inflation more than tort reform, as has been repeatedly shown, although I think that tort reform should be implemented as well.
The description of the voucher system in this video is rather deceptive, by the way. At the start of the video, the spokesperson talks about seniors being given a big chunk of money, but he only and very quickly glosses over the benchmark that adjusts this amount for inflation over time. The fact that the vouchers grow with general CPI rather than health related inflation indexes means that in 20 years, the amount of money will be inadquate for most Americans within the government payment side, while the faster growing prices on the private payer side will leave few options. This is far worse than the death panels that Palin decried, and even conservative elderly are giving Paul Ryan hell over this. The voucher system throws folks out of the health care system and into the uninsured situation, which is the costliest group to deal with within the health care system. Not a great solution.
The reality is that the skyrocketing of health care costs needs to be addressed, not just the government side, which actually has seen prices increase less rapidly. And the way to do this has less to do with relying on Moore’s law or increased market competition, and more on the kinds of solutions implemented elsewhere in the world, whether that be the UK socialized system or the German regulate-it-like-a-utility model. But making up stories like CATO is doing should not cut it. They are merely shilling for private companies as they always do.
I would suggest that your appreciation for a sport is proportional to the amount of time spent learning it.
Professionals athletes, whatever the sport, are not normal people. The things they do can’t be done by normal people.
Given enough time, most hitters can catch up to a 95 mph fastball. But add a slider or change-up and you’ve separated the major league professionals from the minor leaguers.
The rest of us are left playing slow-pitch softball.
Baseball could go the way that boxing did – WWF. In the arena of wrestling, it’s not only perfectly acceptable to suck on steroids, but the wrestler’s career is enhanced. Why not separate them into two leagues.
Oh, and they hit balls. And of course, they spit.
Bookworm: You forgot the high light – they scratch
Hey. The camera is supposed to pan away while they scratch.
And while they smoke.
All this talk about steroid abuse just reminds me of Native Tongue by Carl Hiaasen, or however the heck you spell his last name. Very, very funny.
What was your primary point again, Book?
JJ nails the ironic aspect of Bonds. He was a superb player; possibly an all time great. if had just played it straight. But, he thought he had to have an edge, and was willing to cross the line to get it.
Hey, is he a metaphor for politics?
What a gem of a piece on the mechanics of baseball, jj. When the sun is shining on the Strait of Juan de Fuca and you are in a writing mood, some fine stuff comes out of you, man.
>>ueber-laissez-faire>>
That’s just wrong.
Worse than mixed metaphors??
So much that could be discussed. Even cutting out more than a third of the 20 extractions of abc’s arguments I wanted to comment on, this is way too long. Sigh. I am sure I should be pithier and more limited in range. I hope it’s entertaining enough to be somewhat worth the length. Ah well, here goes.
I’ll start with the general observations: Yes, the video was simplistic (on purpose). So was your argument (likely not on purpose). At my best count, his was 860 words, yours was 1300; therefore yours was about 50% longer. He focused solely on Medicare; you went after the entire health care system, which is not exactly a fair form of rebuttal, is it? But it allows you for these factors to claim he’s being too simplistic. He also spent a great deal of his limited space providing a solution, and nowhere in your entire argument is a solution actually offerred. I suspect you’d have had to go twice as long for that, making his argument *appear* to be even more simplistic. If you’d followed his form, and described the problem and an exact solution, and cut yourself off at 860 words, I wonder how well you’d have done.
On to the specifics I’ve decided to try to limit myself to, for better or for worse.
abc: For those that have researched this issue, and are in command of the many facts left out by this video, it is really rather flawed in its analysis.
Appeals to authority via supporting links is a strongi technique. *This* however is the kind of appeal to authority that, like ad-hominem attack, is rejected as a logical fallacy.
abc: The first thing to understand is that there is no free market for delivering ethical health care anywhere in the world, including ueber-laissez-faire economies like Hong Kong. And there is a reason for this. Ethical health care has inherent market failures that make such a free market system impossible to implement.
The plan takes a single government fund and redistributes the money to consumers. How does *that* have ahything to do with the free market? You return over and over again to this; As such, all of your “free market” comments seem to me to be a straw man argument, which is another of the unfair logical fallacy forms of argument.
abc: it is beyond naive to claim that the free market will handle ethical health care delivery
abc: health care has a ton of other aspects that do not fit the basic assumptions for a free market [...]
- Drug companies hold monopolies. (More correct to discuss patents. This is not free market because…?)
- Drug companies and doctors enjoy information advantages. (This is specifically a free market problem because…?)
- Patients and their families often need to make health care decisions under duress. (This is specifically a free market problem because…?)
Just highlighting the repetition of the “free market” meme as a strawman argument.
abc: In light of this context, it is rather silly to pose as a choice the free market and no-third-party-payment versus government regulated and third-party-payment as a frame of reference. No economist would do this. Only partisan hacks would.
Again, the same straw man. Plus the “limited choices” argument. The presenter outlined the current problem, and the strengths of his proposed solution. He *never* claimed at all that there weren’t other (inferior) arguments out there. That was not part of his purpose.
abc: such a system of implementing best practices is necessary to address the market failures in the system.
abc: The key is to address the market failures in order to ensure that the expenses line up with outcomes, which they currently do not.
Here we see a further layering of the “free market” strawman. Now we’re discussing “market failure of the system”, as if it ever had been a free market system in the first place. I’m grinning widely in disbelief at this one: The free market takes the blame! When there never has been a free market! Takes a special sort of argument to accomplish that trick. Nasty indeed! Nasty.
abc: we cannot tell old ladies or little kids to simply die outside an ER if they lack the funds to cover health care expenses.
Dang, yet another straw man that the poor fellow never said. And no, I’m not taking you out of context.
abc: the return on tangible equity for those companies, which is amongst the highest of any sector of the economy and far in excess of market averages. So the problem of waste, fraud, abuse, etc. appears to exist on the private side as well
This is one of those minor ones I should skip, but heck. Most complaints of this form criticise profit via “return on investment”, not “return on tangible equity”, so this jumped out at me. This is a market sector heavily invested in *research*, not in “tangible equity”. It doesn’t take much “tangible equity” to pump out those little pills, so this is a nifty little substitution. Slides right on into that ol’ cerebral cortex, as slick as can be.
abc: The description of the voucher system in this video is rather deceptive, by the way.
[...] The voucher system throws folks out of the health care system and into the uninsured situation [...]
I didn’t find it deceptive at all. He explcitly made the point that Medicare costs are rising at a much faster rate than the GDP. But more on this later.
abc: As an aside, it is also interesting to note that health care costs are skyrocketing on the private-payer side at a much higher rate than on the government payer side
I’ll quibble a bit, just for fun: This was not an “As an aside”… you return to it again and again, making this one of your critical, main points. But it’s a good detail that I may seek links on for proof, because as a statement of fact it frankly surprises me.
abc: I learned long ago that when something sounds too good to be true, it usually is [...]
abc: We have constructed a system in which the most costly cases are subsidized by the rest of us, since those cases are too expensive for all but the most wealthy of us to afford.
I agree with you here. (This is the “more on this later” part.) The elephant in the room no one likes to say is the word “rationing”. It is avoided like the plague. No solution to the problem can avoid it. This fellow – and Sarah Palin. by the way – object to faceless bureaucrats doing the rationing. For all the avoiding of the word, they simply want to put as much of the “rationing” aspects under the control of the consumer as possible. That, as opposed to faceless bureaucrats – is with precision what they’re up to – and what is wrong with that precise argument?
And finally, the concluding paragraph, which in any good argument is usually the summarization of all that has gone before:
abc: The reality is that the skyrocketing of health care costs needs to be addressed, not just the government side, which actually has seen prices increase less rapidly. And the way to do this has less to do with relying on Moore’s law or increased market competition, and more on the kinds of solutions implemented elsewhere in the world, whether that be the UK socialized system or the German regulate-it-like-a-utility model. But making up stories like CATO is doing should not cut it. They are merely shilling for private companies as they always do.
A quibble (sorry) that you give us a surprise inclusion of Moore’s Law in a summary. Then, a return to the “free market” straw man. Followed by a sudden new insistence on forced choice – generically – that only the category of European-style solutions ought to be considered. Finally, the closing flourish – a flourish of cymbals! – of insulting ad-hominem assault. That’s always such fun stuff to write! And across the entire argument, no solution for the current catastrophically failing system.
Mike, a masterful job of fisking The World’s Greatest Name Dropper! Unfortunately, like the Black Knight in “Monty Python and the Holy Grail,” the poor man won’t realize it until he has bled out.
Mike, I appreciate the reply and the civil tone. Obviously, I disagree with much of what you wrote, but not all. I also wish to clarify some of it, since, contrary to your claim, my argument is in simplified form, as I fully recognize.
Onto your response:
“So much that could be discussed. Even cutting out more than a third of the 20 extractions of abc’s arguments I wanted to comment on, this is way too long. Sigh. I am sure I should be pithier and more limited in range. I hope it’s entertaining enough to be somewhat worth the length. Ah well, here goes…I’ll start with the general observations: Yes, the video was simplistic (on purpose). So was your argument (likely not on purpose). At my best count, his was 860 words, yours was 1300; therefore yours was about 50% longer.”
Sorry about the length, but I didn’t have the time to make it shorter. No second drafts from me on any blogs…
“He focused solely on Medicare; you went after the entire health care system, which is not exactly a fair form of rebuttal, is it?”
Actually, it can be. If the problem is skyrocketing health care costs, and that problem is bigger outside of Medicare than within it, then it actually IS a rebuttal. I think you ought to think through the argument before being so hasty to determine what form my argument/response to the video can take. It actually makes sense to look beyond Medicare for a comparison of health care costs (for a given level of outcomes).
“But it allows you for these factors to claim he’s being too simplistic.”
Not really. My argument about it being too simplistic is that he identifies the problem of skyrocketing costs of Medicare, which we cannot afford to keep paying, lest the program overwhelm the budget, in too narrow of a frame. I identified a lot of other factors that he ignores, which are driving up the costs, both inside Medicare, but even moreso outside of medicare. This is why his oversimplified solution flowing from an oversimplified description of the problem is also flawed, as I also note.
“He also spent a great deal of his limited space providing a solution, and nowhere in your entire argument is a solution actually offerred. I suspect you’d have had to go twice as long for that, making his argument *appear* to be even more simplistic.”
A viable solution to health care in a six minute video. That would be great, but not really viable beyond an oversimplified statement. Also, I do not have a full solution to the problem, but I do (you should be fair and at least acknowledge this…) offer some aspects of the solution, as well as the framework to think of others.
“If you’d followed his form, and described the problem and an exact solution, and cut yourself off at 860 words, I wonder how well you’d have done.”
All this focus on word length… Would you rather have a concise but terrible solution or a verbose but accurate one?? Are you trying to get to some sort of factual accuracy and viable solution? Or do you want to employ every trick in the book merely to win an argument?
“On to the specifics I’ve decided to try to limit myself to, for better or for worse…abc: For those that have researched this issue, and are in command of the many facts left out by this video, it is really rather flawed in its analysis.
Appeals to authority via supporting links is a strongi technique. *This* however is the kind of appeal to authority that, like ad-hominem attack, is rejected as a logical fallacy.”
What is the authority I’ve appealed to here, and why is that authority not in fact an authority? If you cannot answer both of those, it is not a logical fallacy. I think you are trying to put my arguments into a logical fallacy box when they don’t belong there…
“abc: The first thing to understand is that there is no free market for delivering ethical health care anywhere in the world, including ueber-laissez-faire economies like Hong Kong. And there is a reason for this. Ethical health care has inherent market failures that make such a free market system impossible to implement.
The plan takes a single government fund and redistributes the money to consumers. How does *that* have ahything to do with the free market? You return over and over again to this; As such, all of your “free market” comments seem to me to be a straw man argument, which is another of the unfair logical fallacy forms of argument.”
To answer your question, the ”returning” of funds to the consumer means that all the price approval processes behind the Medicare system (which form the basis for the DRG classifications) will go away. You are left with a free market system for pricing health care. The video explicitly states that getting the government and its “distortions” out of the market is a good thing, so things get bought and sold like other commodities like food and furniture. I think it is clear that the video advocates a shift from government-mediated pricing to full free market pricing.
Now, you say that my free market comments are a straw-man argument, but you don’t say why. I say that when you hand over a lump sum of money and get the government and its “distortions” out of the market, as the video recommends, you clearly have a free market and all the attendant problems in this special case of ethical health care delivery. That is hardly a straw man argument, but a statement of where you end up when you follow CATO’s prescription. And CATO wouldn’t disagree, since they have written lots of papers advocating just this move. I think you call it a straw man argument, so you can quickly dismiss it. That isn’t really fair, and even CATO would disagree with your characterization.
“abc: it is beyond naive to claim that the free market will handle ethical health care delivery
abc: health care has a ton of other aspects that do not fit the basic assumptions for a free market [...]
- Drug companies hold monopolies. (More correct to discuss patents. This is not free market because…?)
- Drug companies and doctors enjoy information advantages. (This is specifically a free market problem because…?)
- Patients and their families often need to make health care decisions under duress. (This is specifically a free market problem because…?)
Just highlighting the repetition of the “free market” meme as a strawman argument.”
Economics 101 teaches the requirements for a free market, which include the things I listed above. They are not present in the delivery of ethical health care, which is why no country in the world supplies such goods and services in a free market. This is not repetition, nor is it a straw man argument. You cannot claim that you can harness the free market to deliver ethical health care without addressing all the market failures I mention, but you don’t even acknowledge the problem nor explain why no country delivers ethical health care this way if your assumption that there is no problem really were true.
“abc: In light of this context, it is rather silly to pose as a choice the free market and no-third-party-payment versus government regulated and third-party-payment as a frame of reference. No economist would do this. Only partisan hacks would.
Again, the same straw man. Plus the “limited choices” argument. The presenter outlined the current problem, and the strengths of his proposed solution. He *never* claimed at all that there weren’t other (inferior) arguments out there. That was not part of his purpose.”
It is not a limited choice argument. I am saying that his solution will not work, based upon three sources of evidence:
1. theoretical (too many market failures, since too many assumptions for a free market don’t hold)
2. historical empirical (no country in the world has sought to deliver ethical health care this way)
3. comparative empirical (the health care cost inflation under the non-governmental side is worse than under Medicare)
You cannot simply declare everything I write a logical fallacy without proper basis and declare victory. That is not really fair.
“abc: such a system of implementing best practices is necessary to address the market failures in the system.
abc: The key is to address the market failures in order to ensure that the expenses line up with outcomes, which they currently do not.
Here we see a further layering of the “free market” strawman. Now we’re discussing “market failure of the system”, as if it ever had been a free market system in the first place. I’m grinning widely in disbelief at this one: The free market takes the blame! When there never has been a free market! Takes a special sort of argument to accomplish that trick. Nasty indeed! Nasty.”
There are degrees to which the free market operates under any system. Take the regulated utility industry. How do state PUC’s determine what the “fair” rate of return on equity is allowed? They look at the market, and then they adjust that market rate based upon what incentives they want to create over time, and they also take into account what the longer term trend in market rates is likely to be. This means that even in a regulated industry, the free market plays a role, but the role is more limited than the role it plays in determining the USD:GBP price, which is only impacted by the market and on a second-by-second basis 24/7. The same goes for health care. The free market plays a bigger role in pricing on the private payer side than on the government payer side, and it plays a bigger role in the US than it does in the UK. So you can get cute with your semantics, but you really haven’t disproven much of anything here. There is no trick on my part, just an accurate description of the dynamics involved. I could go on, but you want me to keep it short.
“abc: we cannot tell old ladies or little kids to simply die outside an ER if they lack the funds to cover health care expenses.
Dang, yet another straw man that the poor fellow never said. And no, I’m not taking you out of context.”
I never said that the fellow said it either. But assuming that we all agree that you don’t let people die outside of ER doors, which I do, then you also hae to recognize that a free market system doesn’t apply. It is not a straw man argument, but a clear explanation of why the market for Ferrari’s and Rolexes or Coca-cola and Steelcase furniture are not the same as the delivery of ethical health care goods and services.
“abc: the return on tangible equity for those companies, which is amongst the highest of any sector of the economy and far in excess of market averages. So the problem of waste, fraud, abuse, etc. appears to exist on the private side as well
This is one of those minor ones I should skip, but heck. Most complaints of this form criticise profit via “return on investment”, not “return on tangible equity”, so this jumped out at me. This is a market sector heavily invested in *research*, not in “tangible equity”. It doesn’t take much “tangible equity” to pump out those little pills, so this is a nifty little substitution. Slides right on into that ol’ cerebral cortex, as slick as can be.”
So this little bit reveals how little you understand about analyzing the return of health insurance companies. First, they do not have an R&D budget, since they are insurance companies, not drug companies. Second, all of the health insurance companies that trade publicly have done a ton of acquisitions, so you have to deduct the goodwill that has accumulated on their balance sheet to look at the real returns on their business. That they overpaid massively for acquisitions should not factor into the question of what the real look-forward returns of their operations are, and no analyst would ever look at their returns any other way but on a tangible book equity basis. You could look at the ROIC, but then you have to account for differential debt levels, which only confuses the issue. Assuming that you are after a deeper understanding of health care, rather than simply to win a debate even at the expense of the truth, then you ought to go back and understand what this is about. The upshot of the discussion is important: health insurance companies are massively overearning relative to the average firm in a competitive market. And they can because the market is not operating like a free market should. It proves the point I was making about how market failures are rife in the health care industry.
“abc: The description of the voucher system in this video is rather deceptive, by the way.
[...] The voucher system throws folks out of the health care system and into the uninsured situation [...]
I didn’t find it deceptive at all. He explcitly made the point that Medicare costs are rising at a much faster rate than the GDP. But more on this later.”
It is deceptive, just as Paul Ryan was deceptive in omitting the fact that health care CPI is rising much, much faster than the general CPI. If I grow your allocation for health care by a much lower growth factor than what the prices are really rising, then your purchasing power drops and quickly. This is a key detail that both the video and Paul Ryan have left out in their presentations. At a minimum, the numbers ought to be included, and they were not. It is also deceptive to ignore the fact that government-payer prices are going up far less than private-payer prices.
“abc: As an aside, it is also interesting to note that health care costs are skyrocketing on the private-payer side at a much higher rate than on the government payer side
I’ll quibble a bit, just for fun: This was not an “As an aside”… you return to it again and again, making this one of your critical, main points. But it’s a good detail that I may seek links on for proof, because as a statement of fact it frankly surprises me.”
I am happy to supply you the links for these differential cost increases, assuming you want to learn rather than just win an argument. That it surprises you is not surprising, since many people don’t understand this. That hole in your knowledge is what causes this kind of video to seem compelling when it shouldn’t. And that is what prompted me to make the earlier comment that you (falsely) claimed was an appeal to authority or a logical fallacy, which it is not. If you have all the facts, you will not find this video compelling. That is not a fallacy at all, but a statement of belief founded on credible facts and observations, including mine of you.
“abc: I learned long ago that when something sounds too good to be true, it usually is [...]
abc: We have constructed a system in which the most costly cases are subsidized by the rest of us, since those cases are too expensive for all but the most wealthy of us to afford.
I agree with you here. (This is the “more on this later” part.) The elephant in the room no one likes to say is the word “rationing”. It is avoided like the plague. No solution to the problem can avoid it. This fellow – and Sarah Palin. by the way – object to faceless bureaucrats doing the rationing. For all the avoiding of the word, they simply want to put as much of the “rationing” aspects under the control of the consumer as possible. That, as opposed to faceless bureaucrats – is with precision what they’re up to – and what is wrong with that precise argument?”
Look rationing by price is fine when the market functions, but it is not when it doesn’t. You probably understand why we don’t let the free market set pricing in the utility industry or why we don’t have private armies and fire departments. This is another example. And while I understand why people would think Palin is perfectly reasonable to claim that she’d rather have prices (i.e., consumers) ration rather than government bureaucrats–although, in actuality, Palin made the comments as though there was no price rationalization at all, which isn’t true–the reality is that you cannot rely on the consumer to ration. As I already noted, there is the problem of third party payment in the private system as well, so the consumer is paying with other people’s money since beyond a certain deductible they are buying with funny money. But more importantly, the problems with monopoly power, asymmetric information, decisionmaking under duress, etc. are barriers to making the consumer choice assumptions behind the free market work in this case. That is not a straw man argument. There is an entire literature behind this that qualified health care economists understand. Take a look at Gruber’s (MIT) stuff, for an example.
“And finally, the concluding paragraph, which in any good argument is usually the summarization of all that has gone before:
abc: The reality is that the skyrocketing of health care costs needs to be addressed, not just the government side, which actually has seen prices increase less rapidly. And the way to do this has less to do with relying on Moore’s law or increased market competition, and more on the kinds of solutions implemented elsewhere in the world, whether that be the UK socialized system or the German regulate-it-like-a-utility model. But making up stories like CATO is doing should not cut it. They are merely shilling for private companies as they always do.
A quibble (sorry) that you give us a surprise inclusion of Moore’s Law in a summary. Then, a return to the “free market” straw man. Followed by a sudden new insistence on forced choice – generically – that only the category of European-style solutions ought to be considered. Finally, the closing flourish – a flourish of cymbals! – of insulting ad-hominem assault. That’s always such fun stuff to write! And across the entire argument, no solution for the current catastrophically failing system.”
You might not like my summary, but it is true that CATO has argued that technology (Moore’s Law) and the free market (falling prices) will rule if we move to a completely free market system, although there is little evidence of this for ethical health care. Sorry if the Moore’s Law reference confused you. Furthermore, it is hardly a forced choice to mention the UK or Germany. I use them as examples at either ends of a spectrum of regulated solutions. And these are not merely found in Europe. Japan, Korea, Taiwan, Hong Kong and Singpore have models that fall within this spectrum, with those four being closer to the German model. I do not state an exact solution for the US, but I lay out the problems with the free-market solution and offer some specific solutions to address its failings (e.g., best practice benchmarking to make higher costs correlate with better outcomes, increased purchasing scale by government–or even private companies, for that matter, more information flows from drug companies, insurance companies and doctors, tort reform, etc.), and I offer models that we can look at that have many more embedded solutions to these market failures. The UK and Germany are merely two very different ones across a spectrum of potential solutions. Sorry if my mentioning those two appeared to be a forced choice. It hardly was meant as such.
The bottom line is that a free market solution will not work, and this video ignores the many reasons why. A much longer video about the market failures and the alternative solutions available to address those failures would make a great addition to everyone’s viewing pleasure.
Me 15: Since my comments were nearly all about free markets, and I forgot something implicit that is important, I’d like to throw it out there:
The presenter’s entire focus was on Medicare, and in particular: Hospitals, physicians, and prescription drug (companies). Crosscutting all three of these is the role of insurance companies in managing payments. In each of these four specific subsectors there *are* capitalist and free market elements that exist, in that a company or person has the freedom to join and compete. But the entire industry is so heavily regulated and controlled that I would describe it as not free market at all.
Does the Medicare piece of the puzzle have ANY relationship to those free market aspects of health care itself (diverging from Medicare itself for a moment)?
I thought the whole purpose of the current Medicare system was to remove the free market from that part that Medicare is concerned with (managing the costs of medical care for the elderly if they join the program). If I’m wrong about that, then I’m more than glad to learn the truth.
Therefore, abc’s argument seemed instead to attack those underlying free market aspects of the *entire* health-care system, such as they exist. Seemed to have nothing to do with the Medicare debate itself, which the presenter solely was focused on. That was my major take.
You beat me to it, abc. That was quick.
One more quick one…
abc: I think you call it a straw man argument, so you can quickly dismiss it.
Not my intention. In reading your argument through, it seemed to me you were claiming effects of the free market – and its problems – within the *current* system, not the proposed solution. Plus, I’ll agree that *IF* you extend the argument to the entire health care system, you are dealing much more with free market forces than if you keep the focus narrowly on Medicare. I thought your extension to the entire health care system was simply a big argument oversight – making it indeed a complete strawman argument – but you’ve made it clear in the subsequent you went there on purpose.
(As an aside, I still believe the statement I called an example of the logical fallacy “appeal to authority” was one. ”A says B; A is an authority; A must be true”, it goes.”The fallacy only arises when it is claimed or implied that the authority is infallible in principle and can hence be exempted from criticism.” (Wikipedia). You used some enjoyably snarky phrasing to both establish authority A *and* simultaneously dismiss those not in A. But still.)
AS to the odd focus on word count… I thought the presenter did a fine job in a short time presenting the problem and a clear solution. In going back and forth between it and your rebuttal, I noticed there was no solution in your rebuttal, and I got to thinking about complexity and length of each; and then I wondered just how long each was. The grade-level complexity of each seemed about equal. So I went with “word count” as an intentional device – a focusing device – to frame my response to your argument that he’d been simplistic beyond acceptability. Just a way to try to be both effective and do something argumentatively unique. (I try to entertain. Even when I fail.) It wasn’t a quick trick trying to count the words in that video!
Only when plastered, Charles – I too require performance ehanz… enhazm… emnance… help.
But thank you for the kind words!
Agreed, the solution to our increasing health care costs will come from many sources– of which giving patients more control over their health care dollars will be a part.
I’m interested in what abc means by “ethical health care”, as opposed to unethical health care.
BrianE, ethical health care refers to health care that is medically necessary as opposed to the “unnecessary” elective procedures like lasik surgery or a nose job that would fal under non-ethical health care services. CATO, among other groups, likes to point to non-ethical health care costs to show the “potential” price reductions, if only the government would get out of the way. Now, the government isn’t totally out of the picture even here, since the drugs and devices used in non-ethical health care are also regulated by the FDA. But because these are generally out-of-pocket costs, there is no third-party payment problem. Also, since wealthier people generally get these, the pricing is attractive–and this leads to competition and lower pricing over time. But the lack of third party payment, the ability to forego the service, and the lack of life-in-balance decisions means that this is the subset of health care that CAN look like the sale of food and furniture, which is why the market functions well here. In other words, CATO points to the exception of non-ethical health care to purport to derive rules for the proper delivery of ethical health care. This is not the correct way to look at it, in my opinion, since the underlying assumptions and context are totally different between the cases of ethical versus non-ethical health care, with the latter having the preconditions for a functioning free market.
Lasik surgeries prices are competitive because 1. they’re, well competitive and 2. the Opthamologists don’t own the equipment, they lease it (which I assume possibly has tax advantages plus others).
I suppose we don’t want to see ads popping up on late night tv– “This weekend only– quadruple bypass for the price of a triple. But hurry, this special won’t last long. And we’ll throw in for the first 30 callers a free face lift.”
First off, we need to increase the number of primary care physicians– PA’s and NP’s are going to become the new MD’s, and that’s fine for the cold and flu clinics set up in Walgreens across the country. We have 1/3 fewer physicians than EU countries. I’m on my fourth primary care physician in 10 years at the local clinic.
That alone would force the cost of many procedures down. We have 2-3 times the number of MRI and CATS than Europe. This leads to overutilization which drives prices up without positive outcomes. Once I’m aware of my options, I can make an informed decision whether or not I want to pay for diagnostics that might have lower probabilities of actually helping the diagnosis.
I signed up for an HSA this year and they could be a great tool. Low premiums for high deductible insurance, so I do pay most of regular care– but preventative is 100% paid (some of it) and in a few years, the difference between premiums of traditional insurance and HD insurance will pay all the co-pay for even a serious injury or accident. In the meantime, since I know I’m paying the bill- I do ask the doctor if diagnostics he’s proposing are necessary. I’m choosing exactly the level of care I want, since we know how much of medicine is defensive medicine not for my benefit but to protect the liability of the clinic.
Private insurance costs are going up faster than medicare because of cost shifting and you know that, I’m surprised you would even bring that up as an argument. And Ryan’s plan increases subsidies at CPI plus 1%, so he does account for increasing medical costs. It’s true that they’re rising faster than that now, but I think they can be brought down by some of what I’ve mentioned.
Your red herring of insurance company profitibility is a rather transparent attempt to provoke envy– how dare those evil companies make money! But they do a better job catching fraud than does the government. And yes, I’d rather rationing come from the private sector than bureaucrats in Washington for several reasons. Once the government has decided a procedure isn’t cost effective– it disappears as an option. If the insurance company doesn’t include it in the coverage I do have the option of paying for it myself.
Insurance companies may be driven by the profit motive, the government by ideology, corruption, power, vindictiveness, pettiness, etc.
I am onboard with you about obesity though. It’s a huge cost of health care in the country. AIDs is not as big cost driver, but still big and again, 100% preventable. I’m sure we can come up with a list of unhealthy lifestyles to target. That would be a huge cost saver.
“Lasik surgeries prices are competitive because 1. they’re, well competitive and 2. the Opthamologists don’t own the equipment, they lease it (which I assume possibly has tax advantages plus others).”
The three lasik surgeons I know all own their equipment. But I don’t know what the significance of that is, in all honesty.
“I suppose we don’t want to see ads popping up on late night tv– “This weekend only– quadruple bypass for the price of a triple. But hurry, this special won’t last long. And we’ll throw in for the first 30 callers a free face lift.” ”
We see those ads now. Drug companies are advertising all of the time, which is strange, since the average custoemer is not qualified to evaluate a given drug regimine against some other one. Professionals need to make that call, but the drug companies want the uninformed demanding that their doctor make a certain call that increases drug company profits.
“First off, we need to increase the number of primary care physicians– PA’s and NP’s are going to become the new MD’s, and that’s fine for the cold and flu clinics set up in Walgreens across the country. We have 1/3 fewer physicians than EU countries. I’m on my fourth primary care physician in 10 years at the local clinic. That alone would force the cost of many procedures down.”
There is a large disincentive to go into primary care since there are fewer opportunities for higher cost fee-for-service procedures that draw everyone to specialties. This is the problem that I am pointing to. The market links compensation to the number of procedures rather than to quality of outcomes and the efficiency of obtaining them, which often can come from the GP rather than the specialist.
“We have 2-3 times the number of MRI and CATS than Europe. This leads to overutilization which drives prices up without positive outcomes. Once I’m aware of my options, I can make an informed decision whether or not I want to pay for diagnostics that might have lower probabilities of actually helping the diagnosis.”
Fee for service spurious incentives again. The other point to make is that the patient often doesn’t make the best decision. The doctor knows that the full body scan isn’t needed, but he either wants to make the money or he wants to avoid the lawsuit. The patient has no expertise, so he relies on the doctor. The patient is nervous about their health and not thinking completely rationally either in many cases.
“I signed up for an HSA this year and they could be a great tool. Low premiums for high deductible insurance, so I do pay most of regular care– but preventative is 100% paid (some of it) and in a few years, the difference between premiums of traditional insurance and HD insurance will pay all the co-pay for even a serious injury or accident. In the meantime, since I know I’m paying the bill- I do ask the doctor if diagnostics he’s proposing are necessary. I’m choosing exactly the level of care I want, since we know how much of medicine is defensive medicine not for my benefit but to protect the liability of the clinic.”
I like these programs too, but they only solve part of the problem. They are not appropriate for working families and older people. They also compete with larger-pool programs for the healthier individuals that subsidize the population that uses health care services more heavily. Because those young healthy people will later be old and need care, and want it at lower prices, it is not inherently unfair to want to bring them into larger pools early. Pay more now to pay less later. That is the logic, and the corollary would be that if you opt for the HD plan rather than the larger pool, then you should not get the benefit of that larger pool later (i.e., pay less now, then pay more later).
“Private insurance costs are going up faster than medicare because of cost shifting and you know that, I’m surprised you would even bring that up as an argument. And Ryan’s plan increases subsidies at CPI plus 1%, so he does account for increasing medical costs. It’s true that they’re rising faster than that now, but I think they can be brought down by some of what I’ve mentioned.”
That isn’t accurate. Health care costs in the aggregate are rising at nearly double CPI and have risen at that elevated rate for a long time, which leaves roughly 2 percentage points delta in the growth rate, which is huge if you understand the power of compounding over a decade or more.
“Your red herring of insurance company profitibility is a rather transparent attempt to provoke envy– how dare those evil companies make money! But they do a better job catching fraud than does the government. And yes, I’d rather rationing come from the private sector than bureaucrats in Washington for several reasons. Once the government has decided a procedure isn’t cost effective– it disappears as an option. If the insurance company doesn’t include it in the coverage I do have the option of paying for it myself.”
This is a strange argument. Envy or any other emotion has nothing to do with it. A normally functioning market doesn’t produce returns on tangible equity of 80% when the market norm is at most mid-teens. I raise it not to instill envy in people, but to highlight (quite clearly) that the market is not functioning properly. This is analogous to pointing to an 8’5″ man to show that he has a medical anomoly (e.g., thyroid problem), rather than to incite envy in short men. You are reaching now.
Also, you say that you want rationing to come from the private sector, since they do a better job of catching fraud. But how do you know that this is true? What is your proof? And what is your definition of fraud? If you see that medical outcomes under Medicare are the same as under private payer systems, but that Medicare costs less, then isn’t the excess cost under the private payer system waste, if not fraud? You cannot just assert conclusions without facts…Bookworm’s little front page blurb says that it’s liberals that do that. You are a conservative making the same mistake. Curious.
Further, one has the option theoretically to pay out of pocket for a procedure denied by Medicare. The issue is that medicare is targeted at those who are not wealthy, so they are unlikely to get it. But that isn’t due to something inherent in Medicare. Hence, your final sentence above is incorrect.
Finally, you should know that in an increasing number of cases, private insurers are indexing their pricing structure to Medicare, since they recognize that Medicare is superior at controlling costs. Obviously, they don’t do this across the board, which is why their cost inflation remains higher. But it implies something very different than the story you are telling.
“Insurance companies may be driven by the profit motive, the government by ideology, corruption, power, vindictiveness, pettiness, etc.”
Those are human motivations that exist in all organizations that are run by people. If you think that private companies are devoid of them, you don’t work in one. More imporantly, the relative cost of a profit motive in a non-functioning market often can be worse than the risks you point out and falsely claim are the exclusive province of government entities.
“I am onboard with you about obesity though. It’s a huge cost of health care in the country. AIDs is not as big cost driver, but still big and again, 100% preventable. I’m sure we can come up with a list of unhealthy lifestyles to target. That would be a huge cost saver.”
You have to be careful how you target the behavior. You want to maximize freedom, and make the scope of any intrusions into it as small in scope (narrowly tailored) as possible. I tend to like solutions that maximize information and create incentives and disincentives, rather than eliminating choice, wherever possible. But because these areas are so complex, you have to analyze it on a case-by-case basis, and you have to check your ideology at the door.
> the patient often doesn’t make the best decision. The doctor knows that the full body scan isn’t needed, but he either wants to make the money or he wants to avoid the lawsuit. The patient has no expertise, so he relies on the doctor. The patient is nervous about their health and not thinking completely rationally either in many cases.
Oh, pity the poor patient, totally incapabe of making informed decisions! They can ask the doctor, but the doctor is over there in the corner scheming, scheming – better not trust him! Therefore, we *must* instead trust our Faceless Bureaucrat In the Government. He’ll know what’s best! He’s looking out for me!
The clueless, helpless, totally ignorant, feckless, lost patient! My God, you might almost think that that adult is a little infant. And Mr. Bureaucrat, in his government planning office, is the parent. A parent who loves that patient as if it were his own child. Can you feel the love? Can you see the love!!! It’s there, just brimming over, every day. Yes, that government bureaucrat loves me, and will spend his every waking moment (just like Obama) caring for me.
There’s a reason it’s called Nannyism. This comment is a perfect example of pure liberal government Nanny-ism. I on the other hand do not want that faceless government bureaucrat ANYWHERE near my life.
Mike, with all due respect, you sound totally uninformed on the issue. There is an entire literature in health care economics around the problems of information asymmetries in health care delivery. You reduce it to jingoism, and you do yourself and your readers a tremendous disservice by simplifying complex issues that you do not totally understand. I have supplied evidence and sources that you can go read (negative correlation between health care cost and quality of outcomes; Atul Gawande), but you ignore all of it and make unfounded claims. This is not playing fair, and reveals a desire to conflate and win debates at all cost, rather than attempting to learn what the reality of the problem is, and what workable solutions might exist to improve the current system.
Mike, abc has approved this message (which he sent to me for a final touch-up):
You must understand that I set the terms—and tone—of the discussions here. I do not want to have to repeat that my pure motives allow me to tell you (with all due respect, of course) that you are totally uninformed about an issue when you a.) do not agree with me, b.) do not read the citations I assigned to you, and c.) use colorful language that makes my pedantic prose look more wooden than it really is.
Mike, we all expect better from you from now on.
Charles Martel
LOL. You simply must email Mike the secret handshake and lexicon.
I was just going to remind abc that this, after all, is a literary/current events blog and he should expect an occasional dose of poetic license.
abc, that was condescending.
A Catholic, a Baptist and an Athiest all walk into a bar together….
Mike, I believed you have finally uncovered something. After reading many of A’s posts since he/she/they arrived, it has appeared to me (I certainly expect denial of course) that the ABC existance puts its trust in government over its people. My opinion is that ABC believes that there is more intellect within a government beuracracy than the experts in a given field. I also read the contempt against private doctors much like OB illustrated in his speach not long ago.
Also interesting:
abc: “You want to maximize freedom, and make the scope of any intrusions into it as small in scope (narrowly tailored) as possible. I tend to like solutions that maximize information and create incentives and disincentives, rather than eliminating choice, wherever possible. But because these areas are so complex, you have to analyze it on a case-by-case basis, and you have to check your ideology at the door.”
Except when it comes to healthcare I suppose. Once government begins to manage healthcare, it can begin to manage behaviors to reduce the cost of healthcare (that is my bias showing: I do not trust government because there is no remedy against goernment).
This may be the overall impasse of any further discussions with abc: abc believes in government, I (perhaps many others here as well) do not. Governements role to me: PROVIDE common defense and PROMOTE the general welfare; not the opposite.
This concept may be over simplified for abc’s standards…….. me being the un-washed and all.
Moose writes: ” the ABC existance puts its trust in government over its people. My opinion is that ABC believes that there is more intellect within a government beuracracy than the experts in a given field.”
The experts I cited are not in government, so you are making a false comparison. The experts I cited argue that the government must remain involved. By the way, what experts have you cited??
“ I also read the contempt against private doctors much like OB illustrated in his speach not long ago.”
You read something that is not there. My wife is a doctor, as are my father and brother. And what is a “private doctor”? Is it different than a “doctor”? Or are there corresponding “public doctors” that I didn’t know about??
Moose continues: “Also interesting:
abc: “You want to maximize freedom, and make the scope of any intrusions into it as small in scope (narrowly tailored) as possible. I tend to like solutions that maximize information and create incentives and disincentives, rather than eliminating choice, wherever possible. But because these areas are so complex, you have to analyze it on a case-by-case basis, and you have to check your ideology at the door.”
Except when it comes to healthcare I suppose.”
When it comes to ethical health care, but I’ve already covered that. It’s really easy to criticize an argument that you obviously do not understand. Even Hayek has stated that the government has to remain involved in areas of the economy where the market fails, so this is hardly controversial amongst economists. It’s just the uninformed that continue to assert things that simply are not true. And when they are called out for their lack of information, they react irrationally and badly. But it is almost always better to face facts, rather than continue in ignorance. Sorry if that sounds elitist, but if you insist that 1+1=3, then you are no more wrong than your claims here, which are rife with errors. Others will come to your defense, since they are interested in defending their ideology, rather than establishing facts. It kind of makes a mockery of the blurb on Bookworm’s home page about liberals being the ones confusing facts and wrong conclusions, since conservatives here seem to suffer from the same fallacy.
“ Once government begins to manage healthcare, it can begin to manage behaviors to reduce the cost of healthcare (that is my bias showing: I do not trust government because there is no remedy against goernment).”
Why is that true? Government regulates electricity and gas, but it isn’t managing behaviors related to the consumption of these two commodities. You make unsupported assertions as though they are facts. Exactly the behavior that is supposedly the exclusive province of liberals. Strange.
“This may be the overall impasse of any further discussions with abc: abc believes in government, I (perhaps many others here as well) do not. Governements role to me: PROVIDE common defense and PROMOTE the general welfare; not the opposite.”
I do not believe in government, as you so oversimplistically put it. I believe, like Hayek, that government plays a role when the market fails. i’ve stated that clearly, but you’d prefer to debate a strawman, since that is easier.
“This concept may be over simplified for abc’s standards…….. me being the un-washed and all.”
Not unwashed, but on this issue, uninformed.
The experts just work for the government and it is government bureaucrats and politicians that actually implement and conduct the policies that utilize such “expertise”.
It comes out to be about the same thing. If everything must be managed on a case by case basis, is government going to do it or do we expect to pay scientists and “experts” so called over time?
“It’s really easy to criticize an argument that you obviously do not understand.”
Said Margaret Dumont to the Marx Brothers.
Y, the source I cited, Atul Gawande, is not employed by the government. Stop making stuff up.
> you sound totally uninformed on the issue. There is an entire literature in health care economics around the problems of information asymmetries in health care delivery. You reduce it to jingoism
It’s called basic principles, not jingoism. Jingoism in this case is the use of a more common vernacular, to make a point, rather than high-falutin’ speechifyin’.
As for negative correlations, I’d love to see the negative correlations surrounding government run health care. God help me, I’ve already seen the blizzard of links – on both sides – claiming irrefutable evidence supporting each viewpoint. It’s already been done over and over to no effect whatsoever. But feel free. I’m interesed in being fair, and I have some time, so I will dig up that specific link you mentioned and I will read.
People who become conservative tend to agree that a family is far better equipped to make the decisions that affect them than some anonymous bureaucrat. Conservatives almost always believe the same thing about the free market system. Liberal centralized planners do NOT. Usually, it’s as simple as that.
Allow me to translate one of my uninformed, knuckle-dragging jingoisms:
Part One:
> They can ask the doctor, but the doctor is over there in the corner scheming, scheming – better not trust him!
As the original commenter said, the doctors are beset by conflict of interest. Sometimes. (And none of them are ethically even trying to do their best within a monstrosity of a system.)
Part Two:
> Therefore, we *must* instead trust our Faceless Bureaucrat In the Government. He’ll know what’s best! He’s looking out for me!
But the government bureaucrat has *no* conflicts of interest to ever worry about. Therefore, because doctors are compromised, we must move to a system entirely run by the government, meaning, by its bureaucrats.
Now, I’m not saying some commenters here are driven by socialism and a deliberate desire to control every aspect of free individuals’ lives. Sometimes they are simply certain that a purely objective, intelligent set of non-involved professions should be invested with the power to make all such decisions. And that those decisions, in sum, will be the best decisions that can be made. They’re certain, on principle, that it is the more effective solution. It’s the technocrat approach. To edge on over into “jingoism” again – curse me! – it’s the “trust-the-elite” approach. Aka: “We know better than you what’s good for you.” approach.
My brother and his wife just spent two agonizing months fearing for their son. An original diagnosis of a genetic disease that would be disabling and perhaps deadly over time. Second opinions and specialists. Then the original diagnosis was found to be wrong. Then painful invasive surgery, recommended immediately – then they found it oculd wait until he was sixteen and might not be needed at all. And he can go about his life, with regular checkups for monitoring, until any potential problem surfaces.
They cared, they were committed, they were rational, they worried constantly, they made their decisions. And I’m supposed to believe some faceless bureaucrat in charge of their son’s case could have done even remotely a similar job? You’ll have to excuse me for not thinking so.
I have a neighbor on Medicare. Every day I hear the horror stories of trying to fight her way through a completely uncaring, incompetent, do-nothing bureaucracy. For months, she can’t get *anywhere*. And I’m supposed to believe that adding layer upon layer of further bureaucracy is going to solve the problem? Again, forgive me. I do NOT think so.
Mike remains in an irritable mood. And he continues to claim I have said things that I haven’t. He struggles to think outside his traditional left (bad) right (good) framework, which makes the world intelligible to him.
He writes: “It’s called basic principles, not jingoism. Jingoism in this case is the use of a more common vernacular, to make a point, rather than high-falutin’ speechifyin’.”
Actually, it’s not factually accurate, regardless of the form that it takes. Take for example this little gem: ” They can ask the doctor, but the doctor is over there in the corner scheming, scheming – better not trust him! Therefore, we *must* instead trust our Faceless Bureaucrat In the Government. He’ll know what’s best! He’s looking out for me!”
I didn’t say not to trust the doctor, but to understand that he has a big incentive to over-prescribe treatments that may add little benefit. Warren Buffett wisely stated that one should not ask the barber if one needs a haircut, but this is to sully the reputation of barbers, according to Mike. I don’t think so, nor do most people, who are not scrambling to grasp any straw to hold their factless narrative about health care together.
But the best part is when he totally invents the point that we “must” trust faceless bureaucrats in government since they have a patent’s best interests at heart and know what is best. I have never said anything of the sort. In fact, benchmarking best practices typicaly entails using high-performing doctors as a guide to identify the poorly performing ones and get them to improve. You assume far too much, and it is clearly done to protect your ideology. I have completely undermined the video and CATO research on this topic, so you have little left but rhetoric. But it shouldn’t fool anyone who understands the issues.
CATO and that video are so far to the right of Hayek that it is laughable. And your defending that line of thought versus the mainstream puts you in the same category on this issue.
Mike continues the rant: “As for negative correlations, I’d love to see the negative correlations surrounding government run health care. God help me, I’ve already seen the blizzard of links – on both sides – claiming irrefutable evidence supporting each viewpoint. It’s already been done over and over to no effect whatsoever. But feel free. I’m interesed in being fair, and I have some time, so I will dig up that specific link you mentioned and I will read.”
That is a good question, actually. The research I have read shows that the negative correlation is much worse on the private payer side than on the government payer side, but it exists on both. The likely reason for this discrepancy has to do with Medicare being better at controlling costs for given outcomes, so it relates to the point I made earlier.
I’m glad you are reading Atul Gawande’s stuff. His article in the New Yorker about the two Texas towns is fascinating reading.
“People who become conservative tend to agree that a family is far better equipped to make the decisions that affect them than some anonymous bureaucrat. Conservatives almost always believe the same thing about the free market system. Liberal centralized planners do NOT. Usually, it’s as simple as that.”
This isn’t about centralized planning, so please stop with the you’re-a-communist rhetoric. Hayek warned against central planning in his books, but he also recognized the need for taxation to cover social programs, for government intervention to prevent environmental degradation, and a host of other government activities within the economy. And he called essentially crazy those that claimed that the government should not play a role in the economy. As for the belief in family, that is all well and good, and shared by most liberal families or centrist families as well, in my experience. But laypeople in families still do not have the information or experience of a doctor and cannot always make the right economic decisions, so the free market doesn’t work right. You are making me repeat myself…I’ve already clearly made this point earlier about the market failures that you choose to ignore.
Mike continues: “Now, I’m not saying some commenters here are driven by socialism and a deliberate desire to control every aspect of free individuals’ lives. Sometimes they are simply certain that a purely objective, intelligent set of non-involved professions should be invested with the power to make all such decisions. And that those decisions, in sum, will be the best decisions that can be made. They’re certain, on principle, that it is the more effective solution. It’s the technocrat approach. To edge on over into “jingoism” again – curse me! – it’s the “trust-the-elite” approach. Aka: “We know better than you what’s good for you.” approach.”
What is a technocrat approach? Is that what you would call military planners before a battle or scientists at NIH as they undertake scientific research or government employed physicists as they model out designs for a new weapons system? I guess all of those activities are pretty bogus, since they involve people with specialized knowledge. I hope we don’t have people with advanced degrees in finance, accounting or law in the SEC or the other bodies regulating the financial markets, cause there was no need for such expertise when Greenspan and Summers talked down concerned folks in 2005 regarding the housing bubble… Do these words actually have meaning, or do you select them exclusively for their theatrical effect? Facts do matter, and you’ve done nothing to rebut mine. Your strategy is to apparently just indict them with rhetoric of one kind or another. And while you criticize me for not having a complete solution, you also attack me for proposing communist solutions that I never have proffered. Strange. It seems you want to win a debate, regardless of whether the facts support your case. That is not very helpful to this country, although it is great for your ideology. Which do you care about more? America or conservatism? Which do you love more? Truth or keeping your beliefs even if they are wrong??
Mike again: “My brother and his wife just spent two agonizing months fearing for their son. An original diagnosis of a genetic disease that would be disabling and perhaps deadly over time. Second opinions and specialists. Then the original diagnosis was found to be wrong. Then painful invasive surgery, recommended immediately – then they found it oculd wait until he was sixteen and might not be needed at all. And he can go about his life, with regular checkups for monitoring, until any potential problem surfaces. They cared, they were committed, they were rational, they worried constantly, they made their decisions. And I’m supposed to believe some faceless bureaucrat in charge of their son’s case could have done even remotely a similar job? You’ll have to excuse me for not thinking so.”
I’m glad your brother and sister-in-law had the experience that they did with the doctors. I have had similar experience, and my father and brother went into medicine for the right reasons. But they also have shared stories about a lot of physicians who are far less noble. Anecdotal evidence hardly can hide this fact, since it clearly shows up in the data.
“I have a neighbor on Medicare. Every day I hear the horror stories of trying to fight her way through a completely uncaring, incompetent, do-nothing bureaucracy. For months, she can’t get *anywhere*. And I’m supposed to believe that adding layer upon layer of further bureaucracy is going to solve the problem? Again, forgive me. I do NOT think so.”
Unlike the horror stories of private insurance companies intentionally dragging out payment decisions and hiding behind lengthy litigation because they know the patient will die before the insurance company runs out of money… There are anecdotes on all sides, and while I understand the power of stories as well as anyone, I can create powerful stories that tell a misleading picture. Facts are stubborn things, and the data in this case is really clear. You can tell all the stories that you want but it doesn’t change reality.
It is interesting to watch Mike since it reveals how far people are willing to go to hold onto ideas and beliefs that are incorrect or inapplicable in a given case, in defense of their ideology. I guess the blurb on Bookworm’s homepage applies to conservatives as much as liberals…
Since abc has doctors within his immediate family, I’m sure there is some familiarity with the Hippocratic Oath. Doctors are to provide the patient with all the information and all options available to the patient in order for that patient to make a decision. That’s an INFORMED DECISION. That’s where we are at an impasse: I don’t want the doctor submitting that to the information to the state who then decides for me based on actuarial tables.
abc: “Even Hayek has stated that the government has to remain involved in areas of the economy where the market fails, so this is hardly controversial amongst economists.”
Again, my personal opinion: the healthcare economy is a mess today because there is too much governemnt involvement, thus upsetting the free market. Don’t you love this merry-go-round?
abc: “benchmarking best practices typicaly entails using high-performing doctors as a guide to identify the poorly performing ones and get them to improve.”
I think we see how the governemnt has used this model in the public education system (sarcasm). Why should we expect the government to do a better job in healthcare?
The government has NOT used this model in the public education system. Why do you start with a false statement and use it as a jumping off point for a serious question? Are you serious about the issue or is this the kind of cover-your-ears-and-yell to not hear the truth and reality about a thing. If you could have a better health care system but needed to stop the blind faith in your ideology, would you do it?? Or is it really true that people would rather keep their mythology at all cost?
abc: ” my father and brother went into medicine for the right reasons. But they also have shared stories about a lot of physicians who are far less noble.”
Then, abc: “ Facts are stubborn things, and the data in this case is really clear. You can tell all the stories that you want but it doesn’t change reality”
Finally, abc: “Anecdotal evidence hardly can hide this fact, since it clearly shows up in the data.”
OK, so where do we go from here? I’m confused. But, you knew that already, didn’t you, abc?
Bookworm’s intro page quote: “Conservatives deal with facts and reach conclusions; liberals have conclusions and sell them as facts.”
Moose’s comment: “Again, my personal opinion: the healthcare economy is a mess today because there is too much governemnt involvement, thus upsetting the free market.”
Presented with facts, empirical data and sources, Moose ignores all of it and maintains his unsupported conclusion. Thanks for making a mockery of Bookworm’s front-page blurb.
abc: ” blind faith in your ideology”
I’ll show you mine if you show me yours.
Facts and figures are only ideology to those desperately trying to rescue theirs. Your posts bear no resemblance to mine in terms of empirical support.
Fact: Government has increasingly imposed more and more regulation and price restrictions on healthcare over he last few decades.
Fact: The healthcare costs have continued to rise in the last few decades.
I’d like to see if there is a chart that plots the rate of change of gov’t involvement in healthcare with the rate of change of costs.
abc: “The government has NOT used this model in the public education system.”
My bad, I thought the public education system measured performance. Now you’ve convinced me that they don’t.
Sorry, again. that was ugly. I should have said somehting like: The government has used a performance to measure public education, and we see how well that has worked.
Gotta go back to my cave and club my mate. Sorry I can’t continue.
> Mike remains in an irritable mood.
Speak for yourself! I am positively swimming in a feel-good sea these days! I haven’t been this relaxed and having fun in months. I am on break from work following months of effort and difficulty. ”Bad mood” is about as far from reality as can possibly be imagined!
Sidestroke, breast-stroke, backstroke. Tread some water. Feel-good sea, my man, feel-good sea. I don’t know where you’re coming from. Or where you’re at.
I have had similar experience, and my father and brother went into medicine for the right reasons.- abc
Curious what the right reasons are.
Also, some time ago, on another thread, I asked you where your morality came from?
Since this is quite philosophical, you might answer both questions.
Mike, he’s coming from a gilded, almost all-white ghetto on LA’s west side. Exclusive schools, access to high culture, really, really, really fast Internet access—in short, all of the things that make a life of profound thought and deep insights possible.
Your posts bear no resemblance to mine in terms of empirical support.
That quip has got to be one of the most snottiest and smelly comments I have ever read in this room.
My dear sweet dad (Bless his heart and memory) had a wonderful expression about a neighbor, who felt it was their duty to pontificate with authority on a variety of topics.
“She thinks her sh%# doesn’t stink, but her farts give her away”
Oh, to respond, or not to respond? That is the question! I honestly have no idea whether I should let the oh so very smug accusations of my ignorance and reflexive knee-jerking stand. I’m choosing, Not. I’ll let all his scurrilous defmations, his misrepresentations of my deep love and respect for my fellow countrymen, stand as the BS I call it.
SADIE, at Hahvahd they are called fahts.
Moose: Gotta go back to my cave and club my mate. Sorry I can’t continue.
Once you’ve thoroughly beaten that recalcitrant mate back into line… Come back soon! We’ll miss you while you’re gone!
Pahdon me, Charles Martel
Wow. Looks like the truth hurts, since I obviously touched a nerve. The ad hominem arguments are out in full force. Defensive mechanisms, I guess.
Moose, for the record, please cite the facts that show increasing levels of government regulation of the health care industry and price controls in the US. I’d love to see data rather than unsupported assertions from you, for once.
BrianE, among the many right reasons to become a doctor is putting your patients interests ahead of your own. Doctors that charge more but have inferior outcomes, which my brother and father do not, would not qualify. As for my moral philosophy, that would take more space than this blog allows.
I’m still waiting for a fact-based discussion, instead of unsupported conclusions posing as facts. That is what is advertised at this blog, but I’m still waiting for it to manifest in reality rather than just in rhetoric. How long are you guys going to make me wait?? Insult me personally all you want, or call Harvard names. It doesn’t change the fact that you haven’t rebutted the facts yet. I’ll be waiting and watching to see whether you do, or whether you continue to play rhetorical games to hide the fact that you haven’t.
Y, the source I cited, Atul Gawande, is not employed by the government. Stop making stuff up.
I never mentioned Atul Gawande. Is that person somehow relevant here?
A thinks that what comes through here, are ad hominem attacks? He’s got to be kidding us.
It’s almost certain A’s idea of what jingoism means is as erroneous as his idea of what ad hominem means.
Regardless, healthcare should not be placed in the irresponsible hands of A, Obama, the government, or any of their allies.
I’m still waiting for a fact-based discussion, instead of unsupported conclusions posing as facts.
So basically you concluded that I was “making things up” based upon your unsupported factual-conclusion. Since I never claimed Atul Gawande was employed by the government, your fact must necessarily be non-factual.
So when are you going to follow your own preachings, preacher man?
Y, stop spinning. You wrote: “The experts just work for the government and it is government bureaucrats and politicians that actually implement and conduct the policies that utilize such “expertise”.”
I sourced an expert on health care economics who doesn’t work for the government, and there are many more that argue what Gawande does (e.g., Gruber at MIT). It is tough to have an intelligent discussion with someone who doesn’t mean what he says.
What makes you think I was replying with your comments in mind? Do you have unknown telepathic powers that the government has forgotten to regulate, A…
Who is really spinning their webs of deceit here?
I said experts, but never mentioned a specific person. You don’t even know if I consider your experts to be what I would call experts either. Are you utilizing unregulated and untaxed psychic super powers once more?
I don’t know which narcissistic world you think you are the king of, but in this world, what people are thinking don’t get dictated to by those like you.
Y, please cite a single expert on the subject.